Category: Hard to Reach

People who may have significant barriers to accessing services, reluctance to use them.

Social support for GP patients

As Gateway Healthy Futures is in month 10 of its pilot period, we want to show you the range of support the service offers, by letting you hear two patients’ stories, in their own words.

mini_docGateway Healthy Futures is a GP-referred service, supporting patients with a broad range of social needs. GPs can refer anyone that needs non-medical help, and they’ll get one-to-one support from an experienced para-professional.

What sort of social needs?

From the discussions that took place before we started, we had made a few assumptions about the support that people would need. We had expected to see mostly older people, and for their issues to centre on long term conditions or isolation. We also expected that the level of support provided would vary, from a fairly light touch to working with people more intensively. But we quickly found that the cases being referred to us are a lot more complex than this.

Rather than the frail, elderly demographic that we were expecting, around 70% of the people GPs refer to us are under 65 – and all have needed intensive support from a para-professional Practice Navigator, rather than lower-level support from a Volunteer Befriender.

The most common issues GPs refer patients to us with are related to mental health (for example low reported wellbeing). Social isolation is a big issue, but this isn’t usually related to age – the reasons are many and varied. As well as people who want support to manage long term conditions, we are seeing a lot of alcohol dependency, anxiety and depression, accommodation issues and financial hardship.

How do we help?

The model we use is flexible and so it works for everyone, young and old. The Practice Navigators work one-to-one with patients to come up with a credible action plan, based not just on the needs highlighted by their GP, but on the patient’s own lifestyle and the pace that suits them. We help people to start living more independently almost immediately, and the network Gateway has built up over the years means that we can signpost people to a huge range of other services for help going forward.

Gateway Healthy Futures was designed, and is being piloted, in partnership with MyHealthcare. To find out more, or to refer patients into the service, GPs and Practice Managers should call 0121 456 7820 and ask for Gateway Healthy Futures.

Meet Arlene, Aisha and Brandon

ArleneArlene Lawrence (pictured) is a Practice Navigator with Gateway Healthy Futures. She joined the team from a background in childcare and family work and has been supporting a number of patients with very different needs.

Each patient gets around ten sessions of support, depending on their needs, and these sessions are patient-driven. Practice Navigators work closely with their clients to come up with an action plan based on their own priorities, which is often hugely helpful in itself as it forces people to focus.

Two of Arlene’s clients, Aisha and Brandon, have recorded some audio so you can hear their stories in their own words.

Aisha’s story

Aisha is in her 30s. She suffers from anxiety and depression and is dependent on alcohol, which has led to her leaving work and missing rent payments. Aisha’s immediate concern was that her landlord was taking her to court over unpaid rent, but she and Arlene have also talked through what she wants and needs in the longer term.

They’ve only been working together for a few weeks but Arlene has already accompanied Aisha to housing meetings, and to the court hearing. She’s referred Aisha to a recovery agency, a counselling organisation and a Health Trainer and – thanks to Arlene’s ongoing support – Aisha has been making the appointments. In the clip Aisha explains the difference the support has made and positive impact Gateway Healthy Futures has had on her life.

Arlene says, “it’s hard because I’m here in a professional capacity, but I do give out a lot of hugs! A lot of people just haven’t had any level of support before, so you have to work together to create the boundaries. Working with Aisha to create an action plan has been beneficial because she knows there’s a cut-off date and she’s had to decide exactly what she wants out of this support and her future. She’s already made a lot of positive changes.”

Brandon’s story

Brandon is 20 and has a learning disability, with related anxiety and depression. He has been living at home but because his family life is quite chaotic, he wants to start living independently. However, until he was referred to Gateway Healthy Futures, he didn’t know where to begin.

Arlene has worked with Brandon to come up with an action plan based on his immediate needs – in this case, applying for the PIP payments he was entitled to – and what he would like to do in the future. He indicated that he wasn’t sure whether he wanted to go to college or straight into work, so Arlene accompanied him to a college for people with learning difficulties to find out more about completing his GCSEs, and helped him to prepare for job interviews by helping him to find clothes and bus fare. In the audio clip, they’re on their way to Rathbone’s – an organisation that Brandon hadn’t been aware of before he met Arlene – who have helped him to find a flat with supported living.

Arlene says, “working with Brandon makes me feel quite positive about young people! The flat where he’ll be living, down the road from his mum’s, is perfect. He’ll have company from his housemates, and six hours of support a week, with cookery lessons and sports activities available to him. He’s finding out what he wants out of life and he’s on track to get a warehouse job or something similar. It’s looking good for him now.”

Gateway Healthy Futures: making a difference

The Gateway Healthy Futures service helps patients who need social support, and we’re keen to take more referrals from GPs to show the benefits of this pilot work.

What is Gateway Healthy Futures?

Gateway Healthy Futures is here to support people with a broad range of social needs. GPs can refer anyone that needs non-medical help, so that includes people who have issues around housing, alcohol, finances, benefits, social isolation, and much more.

Our Practice Navigators support people from the age of 18 upwards, working alongside other services and organisations across the city to provide patients with one-to-one tailored support.

Whether someone just needs a cup of tea and a friendly chat to get through the day, or whether they have complex needs that will require a range of specialist help, Gateway Healthy Futures provides a one-stop-shop into which GPs can refer patients for a range of support.

As part of the Gateway family, our Practice Navigators are skilled para-professionals with a huge network at their fingertips – so if they can’t help, they will know someone who can.

Gateway Healthy Futures was designed, and is being piloted, in partnership with MyHealthcare. To find out more, or to refer patients into the service, GPs and Practice Managers should call 0121 456 7820 and ask for Gateway Healthy Futures.

Read on to find out how the service helped Diane who, without the support of a Practice Navigator, might otherwise have fallen through the net.

Diane’s story

Diane’s GP referred her into the Gateway Healthy Futures service in October last year and she was assigned to Judith, a Practice Navigator.

DianeAt their first meeting Judith and Diane discussed how Diane’s ill health and learning difficulties have knock-on effects for her everyday life. For example, cooking is hard work: she can’t stand for long, finds it hard to grip a knife, and sometimes forgets when things are in the oven.

She finds using the telephone really stressful and struggles with reading due to her dyslexia, so she finds it difficult to manage her paperwork, including bills. She told Judith she was concerned about money, and would like more people to talk to.

The little things

Diane was anxious, lonely and at risk, but it was clear that some help with the little things could set her on the road to a happier, more independent lifestyle.

One of the first things Judith did was to phone the DWP on Diane’s behalf to begin the process of claiming for PIP (Personal Independence Payments; the successor to Disability Living Allowance) in order to help ease Diane’s financial pressures. Diane had also heard about a class she wanted to attend, so they worked out which buses she could take to get there. And they talked about ways in which she could save money, perhaps by changing energy suppliers.

Judith helped Diane set up a filing system, and phoned banks and utility companies to set up new arrangements. She helped her to fill in the application forms for PIP, and then to understand the many letters she received relating to the application.

Financial hardship

We often find that it takes some time before the people we work with feel able to be completely honest about financial hardship and, indeed, it was a couple of months before Judith found out just how little Diane was living on. She was going days without food and had stopped going out because she couldn’t afford bus fare. PIP money would give her a lifeline.

However, after being assessed in December, Diane’s PIP application was declined.

Judith was able to give Diane emergency help over Christmas by giving her bus money from our Hardship Fund, and food parcels from our food bank, including a Christmas hamper, but it was obvious that she would need a longer term solution. With Diane’s need for it increasing all the time, Judith stepped up the pressure to approve the PIP payment.

She got in touch with other services in Birmingham for advice, and wrote a letter to the DWP asking them to reconsider Diane’s circumstances, giving them some extra information that hadn’t come to light as part of the application process and assessment. However, the application was refused a second and third time.

A positive outcome

Finally, Diane’s appeal for PIP went to court.

With the help of an adviser from Freshwinds, Judith and Diane gathered as much evidence as they could to support Diane’s appeal. In May, some four months after Judith’s first phonecall to the DWP, Diane attended a tribunal, accompanied by Judith, and was awarded a “daily living” payment at the standard rate.

Diane’s support from Judith has now ended, but she will still see a Gateway Befriender every now and again to carry on with some phased-down support. Thanks to Judith pushing for a positive outcome, she can now afford food and bus fare, so she’s started going regularly to classes and clubs, where she meets people for coffee and the occasional dance. Her paperwork still causes her some anxiety, but she is much more organised and feels much more able to cope with everyday life.

News about the Gateway Health Trainers service

Health Trainer Richard with a clientAfter a period of uncertainty, we’re pleased to be able to confirm that the Gateway Health Trainers service will be continuing until at least March 2017.

Unfortunately, Birmingham Public Health has indeed ended their funding for Lighten Up, meaning that the Gateway Lighten Up service will end (although it will continue in Solihull).

Health Trainers: onwards and upwards

As Gateway Lighten Up stops taking referrals, we’re expecting an increase of referrals into Gateway Health Trainers. Of course, a Health Trainer is not a replacement for Lighten Up – we’re not a call centre, so we don’t have the capacity to work with as many people – but we can offer an alternative for at least some of the people who would have used Lighten Up, with one-to-one meetings, in person, for people who are looking to make lifestyle changes.

Working with more vulnerable people

New targets for us this year mean that Health Trainers are going to be focusing more on South Birmingham’s vulnerable communities. The service has always been open to everyone in South Birmingham, but this year we will start to specifically target more of the harder-to-reach communities: homeless people, people who’ve experienced domestic violence and substance misuse, and young people.

So we’ve been going out and talking directly with some of the agencies who work with vulnerable people, including Birmingham’s Homeless Services, women’s refuges, probation services and colleges, to make sure they know how to refer into Health Trainers and how we can help.

In fact, the number of Health Trainer clients who fall into the “vulnerable” category has risen anyway over the last three or four years… but in many cases we don’t find out until the client’s been with us for a while. It’s hard to admit you’re struggling, but our Health Trainers work hard to build up the sort of relationship where a client can disclose their personal circumstances and ask for help.

In one case, for example, one of our Health Trainers was working with a woman who was struggling to eat healthily. Eventually she admitted she was finding it particularly hard because she didn’t have a fridge, oven, or hob. Luckily, because South Birmingham Health Trainers are part of Gateway, they have a good knowledge of the support available, and access to an up-to-date network of extremely useful contacts. We helped her by working with her to find out what support was available to her from other agencies, as well as offering food parcels from our own foodbank and others in the city.

Because of the rising number of people who need this kind of extra help, Gateway Health Trainers have also been working with a group of GPs in Northfield, and Birmingham CAB, to offer a pilot programme called the Wellbeing Advisor Scheme. The service combines Health Trainers with social support from CAB to meet the needs of patients who are presenting with an increasing range of social issues, including debt, caring responsibilities, housing problems and social isolation. We often find that, once social issues begin to get sorted out, people are more open to lifestyle changes, so putting them together in this way makes a lot of sense.

… and a bit of good news!

health trainersFinally, Gateway Health Trainers have recently been given a boost, thanks to some new equipment: specialist scales from Benenden. These bariatric scales are designed especially for people who are morbidly obese – but they’re also extremely accurate, so we’re very pleased to be able to use them instead of standard scales. It also means that, rather than having to send people above a certain weight back to their GP to be weighed, we can now do it ourselves. Thanks, Benenden!

Clinical study shows that POWS improve maternal mental health

We talk about “evidence-based” services a lot, but for social interventions such as our Pregnancy Outreach Workers Service (POWS) it can be difficult to find proof that the service is successful without resorting to anecdotes and self-reported data.


However, a group of researchers at the University of Birmingham, funded by CLAHRC (Collaboration for Leadership in Applied Research and Care) West Midlands, have recently published their findings from a clinical study into the POW service – and we’re very pleased to note that it shows clear statistical evidence of benefit to the women we support, particularly with regards to their mental health.

The study

The research took the form of a Randomised Controlled Trial (RCT) – the most academically rigorous way of determining whether a cause-effect relation exists between treatment and outcome.

It looked at 1324 women, some of whom received standard maternity care and some of whom were supported by POWS, and compared outcomes such as antenatal attendance, postnatal depression and mother-to-infant bonding.

The findings

The study found that mother-to-infant bonding is better when mum has the support of a POW.

It also found that, for women who have two or more social risk factors, the intervention of a Pregnancy Outreach Worker was beneficial in preventing postnatal depression.

The study adds, “this finding is important for women and their families given the known effect of maternal depression on longer term childhood outcomes”. It concludes:

This trial provides evidence that a lay support service targeted to women with two or more social risk factors improves aspects of maternal psychological health relative to controls; such improvements are likely to be of lasting impact due to the known effect of maternal depression and poor attachment on longer term childhood outcomes.

This, together with the relatively low costs of the service, means that consideration should be given by policymakers to introduction of a lay support service.

When the trial was being carried out, we worked with a much wider group of women than we do now. The research showed that our interventions have the biggest impact on women with two more more social risk factors – and it is this group that we now work with exclusively.

Our POWs work hard to offer early help to women who are at risk; to make sure that baby arrives safely, and to support mum to be the best parent she possibly can. This study is incredibly helpful in validating the work our brilliant POWs do, and we’re delighted to see it published.

You can read the full study on the BMJ Open website here.

Health Trainers go above and beyond

When you hear the term Health Trainer, you might think of the work they do to support people to diet and get down to the gym.

Health Trainers Josh and WayneBut a Health Trainer’s work isn’t all about healthy eating and exercise. Health Trainers, like all of our services, support the whole person.

We know that people who are in debt or worrying about their housing are less likely to stop smoking or to start eating well. Once someone feels like their life is on a more even keel, however, they are more likely to become physically healthier.

So, for us, it’s important that Health Trainers look at all the issues that their clients face and support them with any changes they want to make. This might mean signposting someone to another agency for help with substance misuse, finances, domestic abuse or housing; or it might mean giving them the opportunity to find – and the confidence to join – community groups or classes.

Health Trainers, like all Gateway’s staff, are trained extensively to equip clients with the latest information on, for example, changes to the benefits system and other social issues that could affect them.

They’re also experts in behavioural change, and the principles of behaviour change apply across the board – so seeing a Health Trainer, and learning how to recognise patterns of unhelpful behaviour, can have a positive impact on all areas of a person’s life.

And, of course, being part of Gateway means that Health Trainers have access to a huge knowledge base and network. So although they can’t be experts in everything, they are experts in finding someone who is!

In some cases Health Trainers get involved with organising groups, classes and events themselves. Just this week we received a letter from Pauline at the Long Term Conditions group that we help to run:

“…we would not have been able to continue with the group meetings without Gateway’s help. All the members of our small committee have long term health conditions and, as each year passes, we depend more and more on Gateway to expertly manage our budget, make all the arrangements for our speakers, catering and venue, arrange transport for those who need it and generally and enthusiastically make tea, answer questions, assist the less able with their lunch and much more………and all with a smile. They also help us to complete the CCG forms and signpost us to services that can help with specific problems… well as encouraging those who are able to go to the meetings that enable us to contribute our opinions (and needs) on health and social services matters.”

Wellbeing Advisor Scheme

One way in which we are currently building on the work that Health Trainers do, and evolving the service, is via a new Wellbeing Advisor scheme.

This is a pilot we set up with a group of nine Northfield Practices within Cross City CCG who form the Northfield Alliance.

All the practices have a Health Trainer assigned to them, so they’re already familiar with the service, but one practice and GP in particular, Dr Peter Arora from Jiggins Lane Surgery, wanted a service that also met the needs of patients who were presenting with an increasing range of social issues, including debt, caring responsibilities, housing problems and social isolation.

So we met with Dr Arora and our Health Trainer Commissioner, Elaine George, to agree how we might be able to support clients, and what sort of referral pathway would work best.

Now, GPs and other practice staff at Northfield Alliance practices directly refer to Health Trainers as before, but the referral form lists any additional social issues and Gateway effectively takes responsibility for that client and any interaction or engagement they have with other agencies.

walkingOur main partner in the scheme is Citizens Advice Bureau (CAB) and in agreeing to be referred to the scheme, patients agree to a referral to both Health Trainers and CAB. Obviously for some people, their social issue takes precedence and in those cases we refer them to CAB initially, but then follow up at a later date to establish if they are at the point at which they’d like to work with a Health Trainer for lifestyle support.

While CAB are the main partner, Health Trainers also direct people to other agencies, such as our own Befriending Service, and of course through setting up group activities themselves such as EXTEND classes, Long Term Conditions groups, and walking groups.

Being able to support the whole person, and provide behaviour change tools to influence all aspects of their life, from health, to wellbeing via finance and housing means, we believe, more sustainable results for that person, less pressure on services such as GP, Social Services, DWP etc and a happier, healthier population.

Sharing our knowledge with the Child Poverty Commission

Did you know that Birmingham has a Child Poverty Commission? The cross-partner Commission, which includes the Council, the University of Birmingham and The Children’s Society, was set up in March last year to look at ways of reducing child poverty and making sure children are not disadvantaged by their background.

It’s early days for this group, though, and the first stage is for them to get the fullest picture of the extent of the issue. So we’re very pleased that they’ve asked us to get involved and share our knowledge.

At its launch, the Council’s press release about the Commission said:

“As well as asking professionals to give evidence, the commission wants to listen to the everyday experiences of children and families living in poverty and understand poverty from their perspective and bring to life the stories of children and families behind the hard statistics.”

We were asked by the City Council to get involved as they recognise that our Pregnancy Outreach Workers Service (POWS) works with some of the most in-need families in the city. The Commission is keen to see case studies and information compiled via our Impact Assessment App, but they’re also really keen to hear some experiences first hand, so they’ll be visiting us in a few weeks’ time to meet some of the families we work with and hear how life is for them.

POWs’ experiences of Child Poverty

mother-babyPOWs support some of the most vulnerable women and families in the city, and they come face to face with child poverty on a daily basis. The issue is immense… and it’s growing.

Some of the women we work with don’t yet have a child so, in these cases, “child poverty” includes the strong potential for the baby to be born into poverty.

More than 75% of the women we support record “Financial Hardship” as a current issue when they are assessed. This means they have unmanaged debt, rent arrears, or a low income and, in many cases, all three. For many of the women we visit, we also record that their living accommodation is unsuitable. This could mean overcrowded, in need of repair, or unsafe, and of course we have to take into account the imminent arrival of a baby. The main barrier the women have to changing this is financial hardship.

Since the POW service changed last April to working with the most vulnerable women only, we’ve seen demand for food parcels and hardship payments double. We are also seeing a growing number of women who are underweight or suffering from dietary deficiencies. This issue becomes a real danger during pregnancy, both to mother and child.

Although we do what we can, there’s a limit. Frequently, despite the hard work of our POWs, we’re not able to make things all that much better. To be honest, we often feel a bit helpless. So we’re very pleased to be able to talk about our experiences to the Commission and, hopefully, help to make a difference.

Celina’s Story

Celina* came to the UK from the Caribbean because she had been suffering domestic abuse from her partner (she has actually suffered a miscarriage in the past as a result of the abuse). Legally she should have returned to her home country by now, but her partner has been threatening her family and she is understandably frightened to return.

Celina’s had a lot of complications and medical issues during and since the birth, but her baby is doing OK. Like most of the women POWS support, Celina has dire financial hardship, and because she is now an overstayer, she doesn’t have any access to funds at all. She cannot claim any financial support and wouldn’t be allowed to work even if she could. She has told us she is worried for her own survival.

Just before Christmas, Celina’s Pregnancy Outreach Worker Jacque took Celina a Christmas hamper which included a few essentials – food, baby items and toiletries – as well as a couple of treats for mum and baby. You can hear Celina’s reaction in the video below.

*name has been changed

New project reveals Birmingham’s hidden extremes

PLEASE NOTE: this story is from 2015 and the Gateway Healthy Futures service ended in 2016. If you have been affected by the issues raised in this story, please click here to see a list of links and phone numbers that might be able to help.

Our new service, Gateway Healthy Futures was launched recently and I must admit that the first few weeks have brought some surprises.

What is Gateway Healthy Futures?

We have known for a long time that some patients repeatedly visit their GP (or even A&E) with issues that are not clinical but social, and therefore could be much better managed using a different set of skills.

gateway healthy futures team
The Gateway Healthy Futures team

Using our many years of experience built up from supporting other groups of people in this way, we came up with a solution: Gateway Healthy Futures, a programme of intervention-based care into which GPs can refer patients. Some would then benefit from having regular meetings with a Befriender, and the more complex clients would work with a Practice Navigator: an experienced paraprofessional.

Thanks to a partnership with My Healthcare, we were finally able to pilot the approach and launched Gateway Healthy Futures in October. We are now very happy to be receiving referrals.

However, the people we are working with are surprising us in terms of need.


After long conversations with GPs and CCGs we had anticipated clients with a range of complexities – some low in terms of need and some higher – but in practice we are finding that ALL our referrals so far have high level of need, and they are all complex cases. All require a Practice Navigator rather than a Befriender. Many have serious mental health issues and, it feels, are close to breaking point.

despair-513530_1920Of course, we expected social isolation to be a key factor and we also knew to expect instances of poor mental health. But some aspects are not in line with our predictions. We thought we’d be working with those aged 70+ but the demographic is much younger; most are in their 50s with our youngest referral being just 35. We also anticipated the client group would be largely male but in fact it’s a fairly even split.

We’ve been providing outreach support to people with intensive needs for years. We work with some of the most vulnerable people in the city. Between them our staff team, which includes two former Pregnancy Outreach Workers, have experienced pretty much all the issues we thought possible. But even so, what we are seeing now through this work is extreme.

In just six weeks our staff have begun working with people who haven’t eaten in days; people wrapped in blankets, too scared to turn on the heating; people who, just for a moment, barred the door because they didn’t want our staff to leave, as they hadn’t had social interaction in so long; and people who are having suicidal thoughts. Basically: people in crisis.

Our Practice Navigators are providing a new point of contact for these clients, giving them reassurance and a number to call when they need to talk. They’re also providing vital practical support, including helping people to learn to cook for themselves, to navigate the forms and systems that will give them the financial support they need, and (for those who can) to get out of the house a bit, as well as signposting them to specialist support. But, to be honest, it feels bleak.

But what about everyone else?

My concern isn’t the fact that we are having to deal with these patients – of course we are adapting; our staff are coping very well, and the feedback from patients so far is incredibly positive. In fact my overwhelming feeling is that it’s a good job we know about them, because we can help.

No, my main concern is: what about all those people who aren’t being referred?

We are only working with a fraction of the GPs in Birmingham. There are people like this – living alone, struggling to deal with everyday life – across the city and across the country. Who do they turn to?

And, even for the people we are able to work with, there are fewer services than ever that we can signpost them to for specialist help. If we can’t help, we will always know someone who can… but specialist services across the city have been cut and are pushed to the limit at the moment. We are signposting people to services who then tell us they have a waiting list of months.

Often people who are in dire need, like our clients, simply don’t know what help is available to them (which is why their natural instinct is to call their GP or the emergency services). We can help the small number of people we’re working with and give them the phone numbers and other resources they need – but, when Mental Health and Adult Social Care services are being reduced so severely, it feels like we’re fighting against a tide.


Gateway Food Bank

We are currently taking donations of tinned goods and baby items for the food and baby bank at Gateway. You can drop donations off at the Gateway offices, or give us a ring on 0121 456 7820 – if you’re local we can even collect.

You can find out more about donating to Gateway in the blog post called Why we are starting our Christmas collection early this year.

“I am here today because of you” – Bushra’s story

Bushra* was referred to the Gateway Pregnancy Outreach Workers Service when her life started unravelling and she didn’t know where to turn. In just a few months she had gone from being a college student, supported by friends and family, to being homeless with two mouths to feed and very little support.

Here, her Pregnancy Outreach Worker (POW) Jahanara tells us Bushra’s story, and we’ve also included some quotes from Bushra herself, because she logged her thoughts on our Impact Assessment App after every appointment.


“I am helping Bushra to build a new life without her family”

Case Study by Jahanara Begum, Pregnancy Outreach Worker.


Bushra had been referred to POWS because of social isolation and short term mental health issues.

Bushra and her baby

When I first contacted her, she said she didn’t want me to meet her at home. So I first met Bushra at her GP surgery, where she was attending an antenatal class. She was stressed and tearful, and told me the story of her pregnancy.

Soon after arriving in the UK with a student visa, Bushra had met a man at a bus stop. They got chatting and, thinking that he came across as a very Islamic, “good” man, she gave him her number. Over the next few weeks they spoke on the phone and met once, at McDonalds. He told her he would like to marry her; that he had spoken to his family and they had agreed.

One evening he phoned and asked Bushra to go out and meet him in his car, which she did. It was only the third time they’d met, but he took her to a hotel, telling her it wouldn’t matter if they took their relationship further because they were going to get married.

Bushra believed him.

When Bushra found out she was pregnant, she phoned her boyfriend but he told her he wasn’t interested. Soon after that he changed his number and disappeared. She had never known his address, so she wasn’t able to find him.


At our first meeting Bushra told me she just didn’t know what to do. She said her family would not accept her now that she was pregnant, and so it was impossible for her to go back to Pakistan. She told me her extended family are so strict that she was afraid for her life, and that of her unborn baby, if she was to return.

She was living with a family friend but she couldn’t stay there for much longer because, once her friend found out she was pregnant, she would probably tell her family. This was why she’d arranged to meet me at the doctors.

Bushra said her student visa would soon expire, which would make her an illegal immigrant, but she felt trapped. She couldn’t go back to Pakistan and had no money or recourse to public funds in the UK.

I am very stressed all the time but now that you’re going to support me, maybe things will get better. You have given me encouragement to think positive about my life.

The first thing we needed to do was to find out what support, if any, Bushra was entitled to. We went to a legal advice centre but they said she was not entitled to any legal aid, so I referred her to Asirt (Asylum Support and Immigration Resource Team) and the British Red Cross.

We went to British Red Cross together and they were very helpful. They made an appointment for Bushra at the Home Office and gave her food vouchers, and travel expenses to attend the appointment. They could only support her until her asylum application had been completed, because their funding is very limited, but advised that she should get support from NASS (National Asylum Support Service).

My family has found out I’m pregnant and they are sending me threatening email. My sister said I will not get away with getting pregnant.

By now, Bushra had moved in with another friend – although this friend had made it clear it was a temporary arrangement. Bushra attended the Home Office in Croydon and made an asylum application; however they did not apply for support for emergency accommodation or financial support because her friend had said she was willing to let her stay for another two weeks.

You have offered to get baby items from the Gateway baby bank, and a food bag. Although my friend provides me with food, I feel like a burden on her. I hate having to always ask her for money but I have no choice.

I contacted the migration helpline and got Bushra to speak to them via an interpreter and do an application over the phone for accommodation. I also gave her food, baby items, toiletries and a moses basket from Gateway’s baby bank.


Bushra wasn’t happy staying at her friend’s property, and her friend made it very clear she wanted her to move out as soon as possible, but Bushra needed somewhere to stay while her application was processed. I spoke to the friend and she agreed to let her stay until she had the baby.

As soon as Bushra had the baby her friend asked her to move out. So I phoned the migration helpline again and explained the situation, and Bushra completed another emergency application over the phone. The Refugee Council rehoused her, on the same day, to accommodation where she will live until her application is processed. They are also providing her with some financial support and helping her with her rehousing application.

I do feel lonely here and miss my friend and her son, so please can you visit me regularly. I have lost my family forever but miss my mum so much. It’s been so long that I have not heard her voice. But what can I do, I just have to live with this reality.

I am still supporting Bushra. I occasionally give her food parcels and baby items, and recently I’ve been trying to get her to visit the local Children’s Centre to meet other mums.

I am grateful to you because you’re the one who directed me to the services that helped me, so I am here today because of you.

*not her real name


Gateway Food Bank

We are currently taking donations of tinned goods and baby items for the food and baby bank at Gateway. The bank is increasingly needed by clients of all our services, not just the Pregnancy Outreach Workers Service. You can drop donations off at the Gateway offices, or give us a ring on 0121 456 7820 – if you’re local we can even collect.

You can find out more about donating to Gateway in the blog post called Why we are starting our Christmas collection early this year.

Thank you.

Newly-launched service will help people towards Healthy Futures

This week has seen the launch of our new “admissions avoidance” pilot project, now called Gateway Healthy Futures.

The Gateway Healthy Futures team L-R: Jennie Haines, EAST Administrator; Chere Bailey, Practice Navigator; Angela Allen, EAST Co-ordinator; Michelle Bluck, EAST Programme Manager; Lindsey Lamont, Practice Navigator; Arlene Lawrence, Practice Navigator
The Gateway Healthy Futures team L-R: Jennie Haines, EAST Administrator; Chere Bailey, Practice Navigator; Angela Allen, EAST Co-ordinator; Michelle Bluck, EAST Programme Manager; Lindsey Lamont, Practice Navigator; Arlene Lawrence, Practice Navigator. (Not pictured: Judith Randrasana)

As we explained in August in our blog post A New Avenue For Gateway, the new project is part of part of My Healthcare and it will tackle the thorny issue of patients repeatedly seeing their GP or going to A&E with issues that could be much better managed using social interventions – for example people who have social issues, or who are mismanaging long term conditions.

Gateway Healthy Futures takes two approaches, both of which have already been proven to work as part of Gateway’s current services:

1) Providing paraprofessional support for those with intensive needs and
2) Providing befriender support for those with lower level needs.

The paraprofessionals that will be working within the Healthy Futures service are known as Practice Navigators. Michelle Bluck, EAST Programme Manager, explains: “Gateway Healthy Futures Practice Navigators are similar to our established paraprofessional roles, like Health Trainers and Pregnancy Outreach Workers (POWs). It will be about them understanding what additional support needs to be put in place around the individual and knowing what is available locally that can be drawn in to plug the gaps.  It wont just be about signposting though, it will be about practically ensuring they’re accessing the help they need.  Like the other roles, they will be able to offer people personalised social support; helping them to navigate systems, registering them for new groups or sessions, or going with them to appointments.”

Meet the team

We now have four Practice Navigators in place, ready to work with patients:

Arlene comes to Gateway Healthy Futures from her role as a Gateway Volunteer Befriender – in fact you may remember her from a previous Friday story, Celebrating Our Befrienders, where we talked about her relationship with her client Jean.

Judith has been with Gateway for some time, too; she started as a Volunteer Befriender, moving on to become a Gateway Interpreter, and later trained in a healthcare role under our Training To Care programme, working with patients at a specialist stroke and brain injury rehabilitation centre.

Lindsey has been a Gateway POW for eight years, having started on the Community Family Workers course with Gateway in 2006.

Chere is new to Gateway but comes to us with a BA Hons in Social Policy and Social Care, as well as experience in working with people with dementia and their carers.

Our volunteers are overseen by a new EAST Co-ordinator, Angela, who also comes to Gateway Healthy Futures from the POW service. Like Lindsey, Angela started with Gateway on the Community Family Workers course in 2006.

EAST Programme Manager Michelle Bluck, who will be overseeing the Practice Navigators, has been with Gateway since its inception. She was instrumental in setting up the POW service and since then has run a number of programmes including setting up and running the Interpreters service and Training To Care.

All have been undergoing intensive training over the last few weeks and are raring to go. Their combined experience, buoyed by extra training, and with the backing of Gateway’s many years of experience providing high level one-to-one social support, puts them in the best possible place to help.

For phase one of the project, the Gateway Healthy Futures team will be working with the following surgeries:

my healthcare logoFrankley Health Centre
West Heath Surgery
Wychall Lane Surgery
Cofton Medical Centre
West Heath Primary Care Centre
Kings Norton Surgery
Woodland Road Surgery
Patients must be referred by their GP to access the service.

Pregnancy Outreach Workers: busy all year round

Although the summer holidays are traditionally a quieter time for many of our services, the Pregnancy Outreach Workers Service is busy all year round. Each of our full time POWs has more than 20 cases at any one time and we’re currently working with 248 women.

Unsurprisingly, since we changed our intake to cover the whole city, working with the most complex cases, we are hearing more and more stories of hardship. Here’s the story of just one of the women we’re supporting at the moment, as told by her POW Sylvia.

I helped Rosa to make a new life away from her abusive husband

Case Study by Sylvia Robinson, Pregnancy Outreach Worker
Sylvia, a Gateway Pregnancy Outreach Worker
Sylvia, Rosa’s Pregnancy Outreach Worker

Rosa and her husband had an arranged marriage in Rosa’s home country. After the marriage, Rosa’s husband flew back to the UK without her, but her family managed to raise the money to send her to the UK. She moved in with her husband but she says he was mentally and physically abusive towards her from the day she moved in.

Last year Rosa became pregnant, but her husband didn’t want her to have the baby. He took her to a clinic, but she didn’t realise he had booked an abortion until the doctor asked “are you sure you want to do this?”. She refused the abortion, but her husband tried this approach three times, taking her to clinics and using physical violence against her to try and persuade her to terminate the pregnancy. On the third visit she was told that her pregnancy had advanced too far for them to go ahead with an abortion anyway, so she was able to keep her child.

Rosa has family in Birmingham so, at four months pregnant, she fled her husband and moved into her cousin’s tiny flat. Her midwife had referred her to the POW service and so I went along to meet her at the flat.

I would describe Rosa as a nervous wreck at that first meeting. Her husband was continuing to phone and text her, making at least 500 contacts a day, so she was very stressed, but she opened up to me and we talked through her options. Her statement on the Impact Assessment App after that first meeting said:

He told me that if I wanted to stay with him I would have to do what he says. I am scared for me and my baby, I have no money and all my clothes are in the house.

My first concern was that she should report the abuse and get some protection for herself. She didn’t know where the nearest police station was – she hadn’t even understood that the police would be able to help her – but over the next couple of visits I encouraged her to make a police statement. She was nervous about what would happen, so I talked it through with her and explained what it might involve. It took a couple of weeks but she eventually went. The police took her very seriously and they began working towards getting an injunction.

He is still phoning the house and we are not answering but I know it’s him.

As a new arrival under a spousal visa Rosa had no recourse to public funds, and most of her belongings were still at her husband’s house. Her husband has a well paid, full time job, but he wasn’t giving any money to Rosa; she literally had only the clothes she stood in. With help from Women’s Aid we got a lawyer involved so that she could sort out her immigration status and become eligible for benefits.

I feel very happy now that I know things are happening for me. Thank you, you are so good to me.

Once things were starting to become slightly easier for Rosa I wanted to help her find somewhere to live; although her cousin’s tiny attic flat had been OK for her temporarily, it wouldn’t have been appropriate once baby came along. I phoned around local hostels, and got her a place at a mother and baby unit. I helped her to register for council accommodation and she began bidding for properties.

I have moved to the hostel. It is alright I have made some friends.

Two months after our first meeting Rosa asked me to go to court to support her with the injunction against her husband. We went together and he was given a restraining order.

mother babyAfter a long time without any money, Rosa eventually started to get income support so, two weeks before the birth, she was finally able to start buying clothes and equipment for her baby.

She was still living between hostels and her cousin’s flat when she gave birth to her baby, but a few weeks later she was housed in a more suitable long term property.

POWS support finishes at eight weeks after birth, so my time with Rosa is nearly up.

Her most recent statement said:

I am feeling a bit stressed right now with a new baby and a house, it is a lot. Just need help getting some furniture. I also want help getting child benefit, you told me that I need a form so I ask you to get me one. I also would like to get my child tax credit, you said you will help me thank you.

Rosa is still being supported by the police, who are going to escort her to retrieve her things from her husband’s house. Her solicitor is helping her to apply to stay in the country indefinitely and will be helping her to apply for rights on behalf of her child, who is not technically a British Citizen.

The solicitor is also helping Rosa to gather evidence about the domestic violence that she’s been subjected to, and she will have to go back to court over the next few months. Her husband continues to contact her and is applying for custody of the baby.